title: A risk-adapted study of cisplatin and etoposide, with or without ifosfamide, in patients with metastatic seminoma: results of the GETUG S99 multicenter prospective study.
abstract: BACKGROUND
  Whether patients with good prognosis and intermediate/poor prognosis advanced seminoma should be treated differently has not been defined.
  
  
  OBJECTIVE
  To assess a risk-adapted chemotherapy regimen in patients with advanced seminoma.
  
  
  METHODS
  A total of 132 patients were included in this prospective study. Patients with a good prognosis according to the International Germ Cell Cancer Collaboration Group (IGGCCG) were treated with four cycles of cisplatin-etoposide (EP). Patients with an intermediate prognosis according to the IGCCCG (or a poor prognosis according to the Medical Research Council classification) were treated with four cycles of VIP (EP and ifosfamide) and granulocyte colony-stimulating factor (G-CSF).
  
  
  METHODS
  Survival curves were estimated using the Kaplan-Meier method.
  
  
  CONCLUSIONS
  The median follow-up was 4.5 yr (range: 0.4-11.6 yr). Among 108 patients (82%) with a good prognosis who received EP, grade 3-4 toxicity included neutropenia (47%) and neutropenic fever (12%). Among the 24 patients (18%) with an intermediate/poor prognosis who received VIP plus G-CSF, toxicity included grade 3-4 neutropenia (36%), neutropenic fever (23%), thrombocytopenia (23%), anemia (23%), and a toxicity-related death (n=1; 4%). The 3-yr progression-free survival (PFS) rate was 93% (range: 85-97%) in the good prognosis group and 83% (range: 63-93%) in the intermediate/poor prognosis group (p=0.03 for PFS). The 3-yr overall survival (OS) rate was 99% (range: 92-100%) and 87% (range: 67-95%), respectively (p<0.005 for OS). Only four patients died of seminoma or its treatment.
  
  
  CONCLUSIONS
  A risk-adapted chemotherapy policy for advanced seminoma yielded an excellent outcome with a 3-yr OS rate of 96%.
authors.affiliation: Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France. Electronic address: fizazi@igr.fr.
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
authors.affiliation: Department of Medical Oncology, Centre Paul Papin, Angers, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Delva
authors.affiliation: Radiotherapy and Oncology, Centre Galilée, Hôpital Privé La Louvière, Lille, France.
authors.forename: Armelle
authors.initials: A
authors.lastname: Caty
authors.affiliation: Centre Claudius Regaud, Toulouse, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Chevreau
authors.affiliation: Department of Medical Oncology, Centre Eugène Marquis, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Kerbrat
authors.affiliation: Department of Medical Oncology, Centre René Gauducheau, Saint-Herblain, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Rolland
authors.affiliation: Service of Internal Medical Onco-Haematology, Hôpital Les Oudairies, La Roche sur Yon, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Priou
authors.affiliation: Medical Oncology, Department of Clinical Oncology, Centre Alexis Vautrin, Vandoeuvre lès Nancy, France.
authors.forename: Lionnel
authors.initials: L
authors.lastname: Geoffrois
authors.affiliation: GRU Cancer Center, Department of Hematology Oncology, Augusta, GA, USA.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rixe
authors.affiliation: Department of Medical Oncology, Institut Curie, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Beuzeboc
authors.affiliation: Department of Radiotherapy, Hôpital Morvan, Brest, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Malhaire
authors.affiliation: Department of Medical Oncology, Hôpital Saint-Louis, Paris, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Culine
authors.affiliation: Department of Biostatic and Epidemiology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Marie-Stephanie
authors.initials: MS
authors.lastname: Aubelle
authors.affiliation: Department of Biostatic and Epidemiology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Agnes
authors.initials: A
authors.lastname: Laplanche
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005602:France; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D018239:Seminoma / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide
keywords: Chemotherapy; Prognostic factors; Seminoma